Reflux esophagitis is a disease that requires mandatory complex medical treatment, which includes lifestyle correction, maintaining a therapeutic diet, the use of medicines and products prepared according to folk recipes. In severe cases of the disease, surgery is prescribed. When prescribing treatment for reflux esophagitis, the gastroenterologist chooses the drugs, relying on data on the causes and symptoms of the disease.

The duration of treatment for reflux esophagitis depends on its form. The non-erosive form therapy lasts 4 weeks. What medications to prescribe and in what dosage - the specialist decides depending on the stage of the disease. In addition to drug therapy, it is possible to take decoctions and infusions of herbs, diet therapy. With an erosive form, treatment increases to 8 weeks and includes the use of hydrochloric acid blockers, healing and hemostatic (if necessary) substances.

In case of complications, concomitant diseases or advanced age, the patient undergoes therapy for up to 12 weeks. With successful completion of treatment, prophylactic use of drugs is recommended in order to achieve remission within six months.

Treatment regimens

1. One drug is prescribed, not taking into account the symptoms and complexity of the disease. Such a scheme is not useful and in most cases has no effect.
2. The second way involves following a specific diet and taking antacids. Depending on the stage of the course of inflammation, substances of different effectiveness are prescribed.
3. The third method is based on the initial relief of symptoms by taking proton pump blockers. The second line is taking prokinetic drugs.

The classical scheme consists of four stages, depending on the stage of tissue damage:

• In the first degree, with mild symptoms, it is recommended to take prokinetic drugs and antacids.
• The second degree requires maintaining a healthy dietary balance and includes the use of acid blockers.
• With a pronounced inflammatory process, proton pump inhibitors, H-2 blockers and prokinetics are prescribed.
• The fourth degree is not treated with medication and requires surgical intervention.

Medicines used to treat

Therapy of inflammation of the esophagus takes place with the use of several groups of drugs. At various stages of the disease, the use of drugs is carried out in a complex manner in different combinations and dosages.

Prokinetics

The active substance affects the muscular activity of the digestive organs, normalizes the tone of the esophageal sphincter. Restoring the normal functioning of the esophagus contributes to the rapid promotion of food, helps to cleanse the mucosa. This group includes Itopride, Domperidone, Motilium. The latter is prescribed in the presence of vomiting and a feeling of nausea. Ganaton helps relieve symptoms in a week, heal in three weeks and has no side effects.

proton pump inhibitors

Drugs that help reduce the production of hydrochloric acid by mucosal cells. They are used to relieve severe symptoms of inflammation and relieve pain. Fast-acting substances with minimal side effects.

The course of therapy is prescribed by a specialist, since prolonged use can lead to bone fragility and affect kidney function. The main drugs included in the group: Omeprazole, Lansoprazole, Pantoprazole.

H-2 blockers

They have a similar effect with PPIs, the action occurs due to the blocking of histamine receptors. The production of hydrochloric acid is suspended, which makes it possible to alleviate the condition of the esophagus and stomach.

The fifth generation of such medicines has been developed. The most effective are Ranitidine and Famotidine. Abrupt cessation of use can lead to a short-term increase in the symptoms of the disease.

Alginates and antacids

With esophagitis, drugs that neutralize the effect of acid on the esophagus are prescribed for a successful cure. Antacids are recommended to drink in liquid form. The duration of the drug is 10-15 minutes. The course of therapy is a maximum of two weeks, since the composition of the funds includes magnesium and aluminum. This group includes Phosphalugel, Almagel, Maalox.

Alginates have a milder effect, so they are prescribed during pregnancy. The composition includes alginic acid, which, after ingestion, forms a protective layer on the surface of the mucosa.

Cytoprotectors

Increase the degree of protection of the mucous layer of the esophagus and stomach with. Tablets help improve blood flow, increase the secretion of protective mucus, lower the level of acidity, while promoting the healing of foci of erosion. The most famous drugs are Misoprostol and Dalargin.

Use of antibiotics for esophagitis

With the phlegmous type of esophagitis, antibiotics are prescribed to relieve inflammation in adult patients and relieve pain. With prolonged therapy, it can develop, therefore, the combined use of antifungal agents is recommended.

Use of other drugs

Ursosan reduces the possibility of tissue damage by gastric juice due to the destruction and removal of bile acids. Trimedat helps reduce reflux and increases the speed of food passing through the esophagus.

Symptomatic therapy

If reflux developed against the background of another disease or pathology appeared as a complication of esophagitis, symptomatic treatment is carried out:

• For neurological and psychological problems, it is necessary to consult a doctor of the desired profile. Sedatives, etc. may be prescribed.
• Antibacterial drugs are prescribed for gastric ulcer. Denol helps to neutralize the action of Helicobacter pylori, improves blood circulation in the walls of the stomach, and alleviates the unpleasant symptoms of the disease.
• With a decrease in immunity, immunomodulators are prescribed.

Also, therapy includes the use of vitamin complexes with a high content of macronutrients to improve the general condition of the body.

Treatment approaches

Depending on the stage of tissue damage, the presence of complications, etc., a suitable treatment method is chosen.

The first includes taking medications for esophagitis of different activity in several stages:

1. Maintenance of a therapeutic diet and the use of antacids.
2. Use of H-2 blockers or prokinetic drugs.
3. Comprehensive intake of PPIs and prokinetics.

The second technique is carried out in three approaches:

1. It is prescribed to relieve symptoms.
2. Taking inhibitors for five days to relieve discomfort.
3. The use of tablets only with an exacerbation of the disease.

The third technique is:

1. For mild inflammation, a short course of antacids or acid blockers and adherence to diet and diet.
2. For stage II treatment, a long course of PPIs or acid blockers and prokinetics. Diet therapy is also indicated.
3. Stage III requires the use of a complex of blockers and PPIs or prokinetics. Instructions for use shows the maximum allowed doses.
4. If previous appointments have not brought effect, surgical intervention is necessary.

Supportive care

Medical treatment of esophagitis is the most effective. After undergoing therapy, it is necessary to adhere to a certain lifestyle and conduct a six-month course of maintenance treatment for reflux.

The use of maintenance therapy, dieting, changing the regimen and some habits, the use of traditional medicine will help to avoid relapse and in the future the disease will not cause inconvenience.

Esophagitis is a disease that is associated with the development of an inflammatory process on the mucosa of the esophagus. This pathology leads to the appearance of burning pain behind the sternum, heartburn and increased salivation, impaired swallowing. Therefore, esophagitis treatment involves a comprehensive and effective. This will avoid the development of peptic ulcers and perforation, stenosis of the esophagus, Barrett's disease.

Features of therapy

How to treat inflammation of the esophagus? The treatment regimen is determined by the course of the disease (acute or chronic form), the nature of the inflammatory process (catarrhal, erosive, edematous, exfoliative, hemorrhagic, phlegmonous esophagitis). It should be aimed at eliminating the causes that provoked the development of esophagitis: smoking, overweight, unbalanced nutrition, stressful situations, elimination of chemical and bacterial agents.

It is completely possible to cure the disease only with an integrated approach: the use of medications, the use of traditional medicine recipes and the transition to a sparing diet.

Therapy for acute esophagitis

If the lesion of the esophageal mucosa develops as a result of exposure to chemicals, then the patient needs urgent gastric lavage. With a mild form of pathology, the attending physician may recommend refraining from eating for 2-3 days, taking antacids (Phosphalugel, Almagel) and H2-histamine receptor blockers (Famotidine, Ranitidine). This will reduce the acidity of the gastric juice, preventing further irritation of the esophageal mucosa.

In severe esophagitis, enteral nutrition, the use of enveloping and antacid agents may be required. If the patient has signs of intoxication (weakness, dizziness, confusion, headache, nausea, drowsiness), then infusion therapy with detoxification drugs is recommended. If the inflammation is caused by infectious agents, then the appointment of antibiotics with a wide spectrum of action is indicated.

If the patient develops a severe stricture of the esophagus (narrowing of the organ to critical values), which does not lend itself to dilatation, then urgent surgical intervention is necessary.

Therapy for chronic esophagitis

This form of the disease usually develops against the background of gastroesophageal reflux disease (GERD). Treatment of chronic esophagitis involves changing the patient's lifestyle, following a strict diet and a special diet. During the period of exacerbation, it is recommended to eat warm pureed food, excluding from the diet foods that can increase irritation of the esophageal mucosa (spicy, fried, fatty, carbonated drinks, alcohol).

The patient should stop smoking and the use of drugs that can reduce the tone of the cardia (sedatives, prostaglandins, tranquilizers, theophylline). Dinner should be 2 hours before bedtime, after a meal you can not take a horizontal position. Gastroenterologists recommend raising the head of the bed 40° to prevent reflux at night. Avoid wearing clothes that are tight around the waist.

Drug treatment drugs include the following:

To increase the effectiveness of drug treatment for patients with GERD, physiotherapy is indicated (mud therapy, electrophoresis of ganglioblockers, amplipulse therapy, balneotherapy). However, during the period of exacerbation or in the case of a severe course of the disease, it is worth abandoning the listed methods.

Features of therapy of some morphological forms:

• treatment of erosive esophagitis involves the appointment of antacids, prokinetics, proton pump inhibitors. Antispasmodics (Drotaverine, Papaverine, Spasmolgon) can be used to relieve pain. The patient must adhere to a dietary diet. If complications develop, then surgery is indicated;
• therapy of acute hemorrhagic lesions of the esophagus requires the appointment of hemostatic treatment. For the rest, the standard therapy regimen is used: antacids, proton pump inhibitors, prokinetics;
• treatment of candidal esophagitis involves the appointment of antifungal agents (Nystatin, Ketoconazole, Fluconazole), for heartburn, antacids and proton pump inhibitors are indicated, for sleep disturbances - B vitamins, sedatives. Without fail, the patient must take immunostimulating agents (IRS-19, Ehingin, Imudon). Particular attention should be paid to nutrition - spices, pearl barley, sweets, mushrooms, alcohol, coffee should be excluded, because the fungus actively grows and multiplies when using these products;
• therapy of phlegmonous esophagitis and abscess requires special attention. Patients need parenteral nutrition, they also prescribe the introduction of blood substitutes, antibiotics, detoxification drugs. Pustules are subject to drainage. With the development of phlegmon, surgical intervention is indicated.

The use of traditional medicine

Treatment of esophagitis with folk remedies involves the use of the following recipes:

Therapy with folk remedies is possible if the patient has no contraindications to its implementation.

diet therapy

Particular attention with esophagitis should be given to the products taken, because there is no specific diet for pathology. During the preparation of the diet, the patient should carefully monitor the reaction of the body to each dish.

However, there is a general list of prohibited products:

• fresh wheat bread;
• Rye bread;
• fatty varieties of fish and meat;
• salted, fried, smoked and spicy dishes;
• conservation;
• margarine and lard;
• barley, millet and barley porridge;
• legumes;
• dairy products;
• soups with meat, fish and mushroom broths;
• fresh fruit (excluding bananas);
• vegetables: tomatoes, radishes, eggplants, raw onions and garlic, radishes;
• coffee and chocolate;
• ice cream;
• carbonated and alcoholic drinks;
• hot spices (mustard, chili, wasabi).

Esophagitis is a disease that can be completely cured, subject to the observance of the daily regimen, nutrition and drug treatment. In the absence of complications in the form of stenosis, perforation, bleeding, the pathology has a favorable prognosis.

Heartburn and a feeling of discomfort in the throat are among the main signs of inflammatory processes in the esophageal mucosa, and they need to be treated by qualified specialists. Moreover, the symptoms and treatment of reflux esophagitis should be constantly monitored by doctors. This is the only way to avoid irreversible changes in the tissues of the esophagus, and the development of complications requiring surgical intervention.

Let's try to figure out what reflux esophagitis is. "Esophagitis" is an ancient Greek word meaning esophagus. The term "reflux" is borrowed from Latin and translates as "flow back".

Thus, both concepts reflect the process that occurs during the development of the disease - food masses, gastric juice and enzymes move backward from the stomach or intestines, penetrate into the esophagus, irritating the mucous membrane and causing inflammation.

At the same time, the lower esophageal sphincter, which separates the esophagus and stomach, does not properly prevent the movement of acidic masses.

In official medicine, reflux esophagitis is a complication of gastroesophageal reflux disease, which is characterized by the reflux of acidic contents of the stomach or intestines into the esophagus.

Periodically repeated aggressive action gradually destroys the mucosa and epithelium of the esophagus, contributing to the formation of erosive foci and ulcers - potentially dangerous pathological formations that threaten to degenerate into malignant tumors.

Causes

Under certain circumstances, gastroesophageal reflux can also occur in healthy people. Frequent cases of the onset of the disease indicate the development of inflammatory processes in the gastroduodenal region.

Among the possible causes of reflux, gastroenterologists distinguish the following pathological changes in the structure and functionality of the digestive tract:

• decreased tone and barrier potential of the lower esophageal sphincter;
• violation of esophageal cleansing, redistribution and withdrawal of biological fluids from the intestine;
• violation of the acid-forming mechanism of the stomach;
• decrease in mucosal resistance;
• narrowing of the lumen of the esophagus (stenosis);
• an increase in the size of the esophageal opening of the diaphragm (hernia);
• violation of gastric emptying;
• high level of intra-abdominal pressure.

Most often, reflux esophagitis occurs as a result of weakening the tone of the muscles of the esophagus against the background of a full stomach.

Provoking factors

There are several etiological varieties of factors that provoke the reflux of acidic masses into the esophagus: physiological characteristics of the body, pathological conditions, lifestyle.

Reflux is promoted by:

• pregnancy;
• allergies to certain types of products;
• binge eating;
• obesity;
• smoking and alcohol;
• poisoning;
• unbalanced diet;
• stress;
• work associated with frequent torso bending;
• autoimmune diseases;
• taking medications that weaken the muscles of the cardiac sphincter.

In addition, reflux disease can occur as a result of prolonged use of a nosogastric tube.

In men, gastroesophageal reflux is observed more often than in women, although science has not established a direct relationship between the disease and the gender of a person.

Symptoms and signs of the disease

When gastric masses get on the surface of the mucosa, a burning sensation occurs in the esophagus, since exposure to acid causes tissue burns.

With a long course of the disease, the symptoms of esophagitis reflux become more pronounced, and other pathological manifestations are added to heartburn:

• belching sour. May indicate the development of stenosis of the esophagus against the background of erosive and ulcerative lesions of the mucosa. The appearance of belching at night is fraught with acidic masses entering the respiratory tract;
• pain in the sternum, often radiating to the neck and the area between the shoulder blades. Usually occurs when bending forward. According to clinical characteristics, it resembles the symptoms of angina pectoris;
• difficulty swallowing solid foods. In most cases, the problem occurs against the background of a narrowing of the lumen of the esophagus (stenosis), which is considered as a complication of the disease;
• bleeding is a sign of an extreme degree of development of the disease, requiring urgent surgical intervention;
• foam in the mouth is the result of increased productivity of the salivary glands. Rarely observed.

In addition to the standard clinical signs, extraesophageal symptoms may indicate the development of the disease.

Signs of an extraesophageal nature

The occurrence of pathological processes in areas of the body that are not directly related to the gastrointestinal tract is not always associated with pathological processes in the esophagus - especially in the absence of severe heartburn.

In the absence of full-fledged diagnostic studies, adequate treatment of reflux esophagitis is not possible.

Extraesophageal symptoms of inflammatory processes on the esophageal mucosa differ not only in the nature of severity, but also in localization:

• ENT organs. In the early stages of the disease, rhinitis, laryngitis and pharyngitis develop, there is a feeling of a lump or spasms in the throat. As the pathology develops, it is possible to develop ulcers, granulomas and polyps in the area of ​​the vocal cords, as a result of which the patient's voice changes, becomes hoarse and rough. In the later stages of the disease, a cancerous lesion of the ENT organs is possible;
• oral cavity. Erosive foci appear on the tissues of the oral cavity when gastric juice enters, periodontitis, caries and salivation develop. Pathological processes are accompanied by bad breath;
• bronchi. There may be nocturnal attacks of suffocation or severe coughing;
• chest, heart. Pain in the sternum is identical to the manifestations of coronary heart disease. There may be additional signs indicating cardiac pathology - hypertension, tachycardia. Without special diagnostic studies, it is almost impossible to establish the cause of the disease;
• back. Back pain is caused by innervation with the gastrointestinal tract, the source of which is located in the sternal spine.

In addition, symptoms may appear that indicate a violation of the functionality of the stomach - nausea, vomiting, bloating, a quick feeling of fullness.

Degrees of reflux esophagitis

The level of complexity of the course of the disease is determined by the stages of its development. In most cases, the development of gastroesophageal reflux disease takes about three years, during which the pathology acquires one of the four forms classified by WHO.

Reflux esophagitis of the 1st degree is characterized by intense reddening of the epithelium of the esophagus and a relatively small, up to 5 mm, area of ​​the mucosal lesion zone with point erosions.

The second degree of the disease is diagnosed in the presence of erosions and ulcerative areas against the background of edema, thickening and bruising of the mucosa. With vomiting, partial rejection of minor fragments of the mucosa is possible. The total area of ​​lesions occupies about 40% of the surface of the esophagus.

For the third degree of reflux esophagitis is characterized by an increase in the area of ​​the lesion up to 75% of the surface of the esophagus. In this case, ulcerative formations gradually merge into one.

The development of the fourth degree of the disease is accompanied by an increase in the size of ulcerative areas. Pathological formations occupy more than 75% of the mucosal surface and affect the esophageal folds.

In the absence of treatment, necrotic processes develop in the tissues of the esophagus, leading to the degeneration of cells into malignant ones.

Types of disease

The development of reflux esophagitis can take place in acute or chronic form.

The acute form of reflux is the result of a mucosal burn under the influence of gastric juice. It is most commonly seen in the lower esophagus and responds well to treatment.

The chronic form can occur both against the background of an untreated exacerbation, and as an independent primary process. The chronic course of the disease is characterized by periodic exacerbations and remissions.

Diagnostic measures

Despite the possible severity of the clinical manifestations of reflux esophagitis, additional information is needed to make an accurate diagnosis, which is obtained through examination.

The most informative are such studies as:

• blood analysis;
• Analysis of urine;
• radiography of the organs of the sternum;
• endoscopy - a procedure that allows you to identify erosive and ulcerative formations, as well as other pathological changes in the condition of the esophagus;
• biopsy;
• manometric analysis of the state of sphincters;
• scintigraphy - a method for assessing esophageal self-purification;
• pH-metry and impedance pH-metry of the esophagus - methods to assess the level of normal and retrograde peristalsis of the esophagus;
• daily monitoring of the level of acidity in the lower esophagus.

Reflux esophagitis is diagnosed in the presence of histological and morphological changes in the esophageal mucosa.

Treatment of reflux esophagitis

Successful treatment of reflux esophagitis involves an integrated approach - the use of drug therapy against the backdrop of changing the patient's lifestyle.

Drug treatment with drugs

The prescription of medications for gastroesophageal reflux disease has several objectives - improving the self-purification of the esophagus, eliminating the aggressive effects of gastric masses, and protecting the mucosa.

The following drugs are most effective for treating reflux:

• antacids - Phosphalugel, Gaviscon, Maalox;
• antisecretory agents - Omeprazole, Esomeprazole, Rabeprazole;
• prokinetics - Domperidone, Motilium, Metoclopramide.

In addition, the intake of vitamin preparations is shown - pantothenic acid, which stimulates peristalsis and contributes to the restoration of the mucosa, as well as methylmethionine sulfonium chloride, which reduces the production of gastric secretion.

Surgical intervention

With the development of reflux esophagitis of the third and fourth degree, surgical methods of treatment are indicated - an operation that restores the natural state of the stomach, as well as putting on a magnetic bracelet on the esophagus that prevents the reflux of acidic masses.

Folk remedies

For the treatment of reflux with folk remedies, it is recommended to use decoctions and infusions from plant materials.

A teaspoon of crushed dill seeds brewed with boiling water effectively eliminates heartburn and stops inflammation in the esophagus.

During the day, you should take decoctions of herbal preparations from the rhizomes of the mountaineer, plantain leaves, yarrow, oregano and chamomile. Before going to bed, teas from mint leaves, fireweed, calendula flowers and calamus root are shown to be taken.

The rule for preparing decoctions is to pour one tablespoon of the plant mixture with a glass of boiling water and incubate in a water bath for 15 minutes.

Diet for sickness

Therapeutic nutrition is designed to eliminate from the diet products that have an irritating effect on the mucous membrane, as well as enhance the production of gastric secretion.

Good results are brought by a diet for reflux esophagitis, which includes the following products:

• soft-boiled eggs;
• low-fat dairy products;
• liquid and semi-liquid cereals;
• steam fish and meat;
• baked apples;
• white bread crumbs.

Under the ban - coffee, alcohol, soda, any acidic drinks, beans and peas, spicy, fried, smoked and salty foods, chocolate and brown bread.

Prevention

Of great importance for recovery and prevention of relapse of reflux is the correct lifestyle. Patients are advised to maintain physical activity, monitor weight, do not overeat, and after eating take walks in the fresh air.

In addition, any load on the stomach area, including tight clothing and tight belts, should be avoided. Bending after eating is not allowed. The head of the bed for a night's rest must be raised by 10-15 cm.

And most importantly - you need to regularly visit a gastroenterologist and pass all the scheduled examinations in a timely manner.

With reflux esophagitis, the tissues of the lower esophagus are damaged by acidic contents thrown from the stomach. This is what explains the unpleasant sensations that disturb a person - discomfort, belching sour, coughing. Similar symptoms inherent in reflux can provoke a variety of reasons. Therefore, only a specialist should prescribe the optimal treatment tactics - what drugs, their doses, duration of administration. Self-medication is unacceptable.

Conducted medical studies have convincingly shown that in order to cope with reflux esophagitis, treatment with drugs should be combined with other measures - diet therapy, correction of the patient's lifestyle. Only to eliminate the true causes of the disease, you can achieve your goal - to prevent the recurrence of the disease, to eliminate discomfort.

Principles of treatment of reflux esophagitis:

• lowering the acidity of the contents of the stomach to acceptable parameters by prescribing appropriate medications;
• optimal stimulation of the motility of the structures of the digestive tract - strengthening their evacuation activity;
• restoration and protection of the mucous membrane of the esophageal tube with drugs.

The causes and treatment of the disease are closely interconnected - by eliminating the first by the influence of the second, the patient improves his own well-being. However, it is not recommended to independently purchase in the pharmacy network and take this or that remedy for reflux disorders. Without knowing the mechanism of pathology formation and the point of application of the pharmacological action of the drug, it is possible to achieve the opposite result - the appearance of severe complications.

Stages of treatment

The treatment regimen for reflux disease involves taking medication in 2 stages:

1. healing of existing mucosal defects, relief of inflammatory processes;
2. restoration of the full activity of the esophageal tube and its natural sphincters.

The first stage requires taking drugs from the anti-inflammatory and anti-ulcer subgroups for at least 6–8 weeks. The duration of pharmacotherapy directly depends on the severity of symptoms and the degree of tissue damage.

At the second stage, the patient takes maintenance doses of medications in order to prevent possible relapse and maximize the restoration of the health of the organ. In severe cases, a person may require lifelong maintenance therapy.

To date, experts have developed several drug treatment regimens for reflux esophagitis, which include drugs with different mechanisms of action and the duration of the desired effect.

Antacids and alginates

The purpose of the use of representatives of this subgroup of pharmaceuticals is the rapid neutralization of hydrochloric acid in the stomach area. In addition, against the background of their use, more bicarbonates are produced, natural defenders of the mucous membrane of digestive structures. They also bind bile pigments and inactivate pepsin.

In most cases, specialists give preference to non-systemic medicines, which contain aluminum or magnesium. Modern antacids:

• Almagel
• Phosphaluge
• Maalox

It is optimal to take them in liquid form, which allows them to be qualitatively distributed over the entire surface of the mucosa.

Antacids are designed specifically to reduce the acidity of gastric contents. The list of contraindications to them is minimal, for example, individual intolerance to active or auxiliary components.

proton pump inhibitors

For the production of hydrochloric acid, special cells of the digestive tract are responsible. To reduce their hyperactivity, which is the main cause of the sour belching symptom, it is necessary to take drugs from the subgroup of proton pump inhibitors.

Representatives of this subgroup, for example, Omez, Rabeprazole, Pantoprazole, have the following pharmacological effects:

• a significant decrease in the level of basal, as well as stimulated emission of hydrochloric acid;
• restoration of the physiological activity of the cells of the gastric mucosa and esophageal tube.

To the undoubted advantages of these drugs, including Omez, experts point out:

1. rapid onset of the desired effect;
2. not absorbed into the systemic circulation;
3. the minimum list of side effects on the patient's body.

Features of the structure of the drug Omez allow you to use it for a long time at the second stage of pharmacotherapy. Symptoms of bitterness in the mouth and discomfort in the epigastric region, characteristic of gastric reflux, due to this, appear much less frequently.

H2-histamine receptor blockers

Effective drugs for esophagitis, which have already managed to prove themselves from the best side both in specialists and in patients, are H2-histamine receptor blockers. Prominent representatives of the subgroup are Ranitidine, Famotidine, Cimetidine, Roxatidine.

Their use has the same goal as proton pump blockers - to effectively reduce the concentration of acid in the digestive juice. They directly affect H2-histamine receptors, prevent their vigorous activity, due to which the production of hydrochloric acid is significantly reduced.

The most effective representatives of this subgroup of medicines are Famotidine and Roxatidine. With their use, there is less likelihood of a withdrawal syndrome.

The undoubted advantages of drugs include:

• a rapid decrease in the production of hydrochloric acid in the stomach;
• a significant slowdown in the secretion of pepsins;
• the possibility of using minimal doses to achieve a therapeutic effect;
• stimulation of the own defenses of the gastric mucosa;
• improvement of local blood supply to tissues and acceleration of their epithelialization.

With esophagitis in adults, H2-histamine receptor blockers are used quite often. However, the optimal dose and duration of administration should be prescribed only by the attending physician.

Subgroup of prokinetics

Tablets for reflux, the main purpose of which is to enhance antropyloric motor function, are representatives of the subgroup of prokinetics. Due to the acceleration of the evacuation of the esophageal bolus from the stomach, there is a weakening of the reflux into the esophageal tube. There is also a pronounced stimulation of the tone of the lower cardia - a muscle ring that normally blocks the entrance to the stomach. The initiation of esophageal self-cleaning is also formed.

Reflux can be cured by:

1. Cerucal, Raglan - have the ability to enhance the motility and tone of the structures of the gastrointestinal tract, as well as sphincters
2. Motilium, Domperidone - the absence of systemic effects is indicated as an advantage
3. Ganaton - the latest generation of prokinetics, helps to accelerate the epithelization of erosions, is effective even with severe inflammation.

How to take prokinetics, their doses and duration of pharmacotherapy should be determined only by a specialist. With a mild course of the disease, it is quite possible to completely cure it.

Subgroup of gastroprotectors

Effective drugs for the treatment of reflux, of course, are gastroprotectors. Thanks to the timely application, they have a beneficial effect on the tissues of the esophageal tube, as they are able to increase the protective functions of the digestive mucus.

Symptoms of the disease disappear much faster if complex pharmacotherapy contains:

• Cytotec
• Cytotec
• Venter
• Ursofalk
• Sucralfate

Symptomatic therapy

Sometimes the aggravation of the disease occurs due to nervous shocks, psycho-emotional overload. In this case, it is not possible to cope with the problem only with the help of the above medicines. To treat reflux requires specialized help from a psychotherapist.

If the symptoms of reflux of the food bolus are combined with spastic impulses, it is enough to take an antispasmodic, for example, Duspatalin. After elimination of the hyperspasm of the smooth muscles of the intestinal loops, relief of well-being occurs.

If a person prefers homeopathy, it should be taken into account that with its help it is possible to cope only with the initial stage of the disease. In severe cases of reflux, multicomponent pharmacotherapy is necessarily prescribed.

This information is intended for healthcare and pharmaceutical professionals. Patients should not use this information as medical advice or recommendations.

The use of Gaviscon for the treatment of gastroesophageal reflux disease - the solution of multidisciplinary problems

PhD N.V. Topchy
Association of General Practitioners of the Russian Federation, Moscow

Over the past decades, the clinical and epidemiological structure of gastroesophageal reflux disease (GERD) has acquired an actual large-scale significance in the world, due not only to the expansion of complaints of a “multidisciplinary” nature, but also to the growth of such complications as Barrett’s esophagus and esophageal adenocarcinoma, as well as the duration of drug therapy and in some cases requiring surgical intervention. GERD is rightly considered a disease of the XXI century against the backdrop of a downward trend in recent years, the incidence of gastric ulcer and duodenal ulcer. Thus, heartburn, which is the most characteristic symptom of GERD, worsens the quality of life in 60% of European respondents, and the degree of deterioration is comparable to the situation in patients with coronary heart disease, arterial hypertension. Most of the ongoing epidemiological studies on the prevalence of GERD are based on the study of the main clinical symptom - heartburn and / or the results of esophagogastroduodenoscopy (EGDS) with the detection of reflux esophagitis.

The method of individual questioning of the population about the presence of heartburn allows to identify in patients such symptoms of GERD as chest pain, feeling of acid in the mouth, burning tongue, regurgitation of food or acid from the stomach into the pharynx and oral cavity and associated discomfort, saliva flow from the mouth in the morning (“wet pillow symptom”), the relationship of these symptoms with food intake, its nature (fatty, spicy, sour, carbonated drinks, etc.), with the time of day (day or night symptoms), changes in body position (taking horizontal position, torso tilt), physical activity, leading to an increase in intra-abdominal pressure, as well as the frequency of these symptoms (1 time per month, 1 or more times a week, several times a day). According to the results of Russian epidemiological studies conducted in Novosibirsk, St. Petersburg and Krasnoyarsk (1700, 1898 and 508 respondents, respectively), it was noted that about 60% of Novosibirsk residents and approximately 46% of St. Petersburg and Krasnoyarsk residents suffer from heartburn. The average prevalence of GERD in Russia is 13.3%.

The data for Russia differ little from those obtained in Europe and the USA. Currently, GERD is considered as a chronic relapsing disease caused by a violation of the motor-evacuation function of the gastroesophageal zone and characterized by spontaneous or regularly repeated throwing of gastric or duodenal contents into the esophagus, which leads to damage to the distal esophagus with the development of erosive-ulcerative, catarrhal and /or functional disorders. For a long time, GERD has gone beyond the scope of gastroenterology itself and has become the subject of close study by specialists in various fields: cardiologists, pulmonologists, otorhinolaryngologists, surgeons, and even oncologists (Table 1).

Table 1 Syndromes associated with GERD (Montreal, 2005)

Esophageal syndromes		Extraesophageal syndromes
No damage to the esophagus	With damage to the esophagus	Linked to GERD	Suspected association with GERD
typical reflux syndrome Reflux chest pain syndrome	Reflux esophagitis Reflux strictures of the esophagus Barrett's esophagus Adenocarcinoma of the esophagus	reflux cough syndrome Reflux Asthma Syndrome Laryngitis Erosion of tooth enamel	Pharyngitis Sinusitis Recurrent otitis media Idiopathic pulmonary fibrosis

In 2008, the American Gastroenterological Association (AGA) practice guidelines were published, summarizing evidence-based medicine for the management of patients with GERD. The need for non-pharmacological correction was identified, in particular, modification of the patient's lifestyle to alleviate the symptoms of GERD:

1) avoid eating foods that can cause reflux (coffee, alcohol, chocolate, fatty foods);

2) avoid eating acidic foods that provoke heartburn (citrus fruits, carbonated drinks, spicy foods);

3) behavioral correction that helps to reduce the effect of acidic contents on the esophageal mucosa (weight loss for patients with obesity and overweight, smoking cessation, raising the head end of the bed, vertical position for 2-3 hours after eating). However, lifestyle modification measures should be carried out taking into account the individual characteristics of the patient with GERD and the individual clinical picture of the disease. So, if the main symptom is heartburn or regurgitation at night, disturbing sleep despite antisecretory therapy, then raising the head end of the bed can be recommended as a non-drug effect. Patients suffering from heartburn after eating certain foods should avoid taking them, etc. . The main direction in the treatment of GERD at present is the use of antisecretory drugs. Currently, the leading positions in the treatment of GERD, regardless of the clinical and endoscopic variant, are occupied by proton pump inhibitors (PPIs), which effectively suppress the production of hydrochloric acid in the stomach, thereby helping to maintain intraesophageal pH over 4 for a long time. However, the appointment of PPIs for the treatment of endoscopically negative GERD is not always justified: along with the acid aggression of gastric juice thrown into the esophagus in patients, a violation of the kinetic properties of the upper parts of the digestive tube, manifested in disorders of both primary and secondary (and sometimes tertiary) peristalsis of the esophagus. This fact is confirmed by positive clinical dynamics during treatment with prokinetics. The dynamics of this direction is also noted in the treatment of "extraesophageal" manifestations of GERD. Powerful acid suppression is not always appropriate and justified in children, in patients during pregnancy, in the presence of concomitant diseases of the cardiovascular system, etc. Thus, it is known that the recurrent course of chronic pancreatitis (CP) leads to the development of dystrophic, and later atrophic changes. duodenal mucosa, manifested by a deficiency in the production of gastrointestinal hormones (secretin and cholecystokin-pancreozymin), causing duodenostasis, spastic dysfunction of the sphincter of Oddi, an increase in pressure in the pancreatic ducts, a decrease in the volume of pancreatic juice due to the liquid part and secretion of bicarbonates. As a result of this cascade of reactions, on the one hand, gastroesophageal reflux intensifies, on the other hand, various sections of the pancreatic ducts are blocked by protein precipitates, provoking an exacerbation of CP with the development of abdominal pain, and as the pathological process progresses, exocrine pancreatic insufficiency. Under conditions of intense and especially prolonged acid suppression, hypochlorhydria, which is formed already at the level of the stomach, leads to impaired activation of pepsinogen into pepsin (optimal pH = 1-3). As a result, the initial stage of protein digestion is disrupted - breaking the bonds between aromatic amino acids, which makes it difficult for the further process of proteolysis of poly- and oligopeptides that enter the duodenum with intact peptide bonds, leading to greater stimulation of secretin and cholecystokinin production and an increase in the viscosity of pancreatic juice, a decrease in enzyme production pancreas and, as a result, to an increase in pain and aggravation of pancreatic insufficiency. At the same time, it is important to note that a pronounced suppression of hydrochloric acid production not only has a negative effect on the gastric phase of digestion and the normal course of intragastric proteolysis processes, but also causes a number of undesirable side effects in the form of parietal cell hyperplasia, histamine-producing cells of the gastrointestinal APUD- system, hypergastrinemia, the appearance or intensification of flatulence and diarrhea, etc. In turn, the use of H2-histamine blockers quite often causes such side effects as "rebound syndrome" or "withdrawal syndrome", which also limits their use for long-term therapy of patients.

In addition, in some cases, GERD develops against the background of pathological reflux of alkaline gastric contents into the esophagus, to reduce the “aggressive” properties of which, in order to bind bile acids and lysolic acid, it is necessary to prescribe antacids, enterosorbents, or ursodeoxycholic acid preparations. The urgency of the problem of combined diseases is due to certain difficulties not only in diagnosis, but also in the selection of high-quality and justified therapy, since the likelihood of developing side effects also depends on the number of medications taken. In this regard, one of the most important issues in the treatment of patients with a combination of GERD is the problem of overcoming polypharmacy, especially relevant in the treatment of the elderly and the appointment of drugs with a summative clinical effect. It is known that the pharmacological action of antisecretory drugs and antacids is fundamentally different. If the former more or less persistently and for a long period (depending on the group affiliation and properties of a particular drug) inhibit the process of acid formation in the stomach, which is closely coordinated with the motility of the upper digestive tract, then the latter neutralize hydrochloric acid already secreted into the lumen of the stomach for a short time. . At the same time, the advantages of modern antacids over drugs of other pharmacological groups used to treat acid-dependent diseases are the rapid relief of pain and dyspepsia, the ability to adsorb bile acids and lysolecithin, positively influence the rate of evacuation from the stomach, and correct intestinal motility disorders. The diverse properties of antacids and a wide range of indications for their use have led to the creation of a large number of drugs that are heterogeneous in their properties and mechanism of action. Currently, only insoluble (non-absorbable) antacids are recommended for use, since soluble (absorbable), in particular, sodium bicarbonate, etc., act quickly, but for a short time, often cause the “rebound” symptom, sometimes alkalosis, an increase in circulating blood volume, in connection with which they are practically not used.

Alginates are natural polysaccharide polymers and can be classified as fiber. For the first time alginic acid (from lat. alga - sea grass, seaweed) was discovered by the English chemist T. Stanford in 1881 when obtaining iodine from seaweed. The source of alginic acid is brown algae, mainly Laminaria hyperborea. Alginic acids are built from residues of D-mannuronic and L-guluronic acids. The mannuronic acid blocks impart viscosity to alginate solutions. Gelation occurs by the association of guluronic acid blocks with the participation of a calcium cation, which "crosslinks" the polysaccharide chains. The ability to form viscous solutions and gels, combined with safety, has made it possible to use alginic acid derivatives in the food, cosmetic and pharmaceutical industries for over 100 years. In the acidic environment of the stomach, both alginic salts and alginic acids precipitate, forming a viscous gel. The gel is rapidly formed under the influence of gastric acid, forming in laboratory (in vitro) conditions within a few seconds, and in natural (in vivo) conditions within a few minutes after taking the drug. The ability of alginate formulations to form a floating, gastric-retained foam led to the initial development of an alginate-containing preparation as a radiological contrast agent. However, it was quickly established that this compound has an effective curative effect in symptomatic reflux esophagitis.

The effectiveness of Gaviscon and Gaviscon forte preparations is due to the peculiarities of their composition. Gaviscon consists of sodium alginate (500 mg / 10 ml), sodium bicarbonate (267 mg / 10 ml), calcium carbonate (160 mg / 10 ml) and a number of auxiliary components. Gaviscon forte - from sodium alginate (1000 mg / 10 ml), potassium bicarbonate (200 mg / ml) and excipients. At the same time, the main pharmacological and clinical effects are associated with alginic acid. The ability of alginates to stop local gastric bleeding (hemostatic properties) and stimulate the healing of erosive and ulcerative defects (cytoprotective properties) are used in the treatment of diseases of the stomach and esophagus caused by acid "aggression". Alginic acid, enveloping the walls of the upper sections of the digestive tube, significantly weakens dyspeptic and pain sensations. The main mechanism of action of alginate-containing preparations is the formation of a mechanical barrier ("raft"), which prevents the contents of the stomach from being thrown into the esophagus. At the same time, sodium (or potassium) bicarbonate, being a source of CO2, when interacting with hydrochloric acid of the stomach, gives the “raft” buoyancy, while calcium carbonate binds long alginate molecules to strengthen the resulting protective barrier. It is important to emphasize the absence of systemic action of Gaviscon and Gaviscon forte alginate preparations, the mechanism of action of which is of a physical nature. Gaviscon and Gaviscon forte are characterized not by a short explosive, similar to all antacids, but by a long-term persistent action due to the formation of an alginate "raft" - gel. The antireflux properties of these drugs in some way can be called universal not only in terms of their significance and time interval, but also in terms of their qualitative characteristics. By creating a protective barrier on the surface of gastric contents, they are able to significantly and for a long time (more than 4.5 hours) reduce the number of pathological gastroesophageal and duodenogastroesophageal refluxes, thereby creating conditions for physiological rest for the esophageal mucosa.

The versatility of these drugs lies in the possibility of their effective action in any range of intragastric pH in the case of both acid and alkaline refluxes. It is also important that their use transforms the pathological significance of reflux into a healing one: the gel-forming substance regurgitated into the esophagus has a beneficial, rather than damaging, healing effect. In addition, the pharmacological compatibility of alginates with antisecretory drugs for the treatment of severe forms of diseases has been proven. Positive is the fact that Gaviscon and Gaviscon forte do not affect the pharmacokinetics of co-administered drugs.

A study by S. Sandmark and I. Zenk (1964) to evaluate the clinical efficacy of drugs containing alginic acid and sodium bicarbonate in 93 patients with hiatal hernia and symptoms of reflux esophagitis revealed a significant relief of symptoms of reflux esophagitis in 74% of patients. D. L. Williams et al. evaluated a liquid alginate preparation for the symptomatic treatment of heartburn, belching and dyspepsia in 596 adult patients in the first aid department. Processing of special card-journals with registration within 2 weeks. patients of these symptoms confirmed a decrease in the intensity and frequency of symptoms in 82% of patients. Thus, the drug was found effective in 327 (75%) of 435 patients suffering from heartburn, and in 324 (72%) of 451 patients who complained mainly of dyspepsia. In a study by H.J. von Hurt et al. more than 94% of 2927 patients with complaints of heartburn and dyspepsia when taking a liquid or tablet alginate-containing preparation gave it a positive assessment. The publication by T. Poynard confirms the effectiveness of liquid Gaviscon in preventing the recurrence of previously treated reflux esophagitis, mainly in non-severe forms of the disease. All 1030 patients included in the study, who initially had grades 1 (57%), 2 (33%), and 3 (9%) of esophagitis, were pre-treated with an H2-receptor antagonist or PPI with clinical and endoscopic confirmation of cure. Patients were instructed to take the drug only in case of recurrence of pain requiring more than 8 doses of the drug within 48 hours or more. After 6 months of follow-up, it turned out that Gaviscon prevented the recurrence of the disease in 85%, 69% and 56% of patients, respectively.

About 95% of patients took the drug less than 2 times a day. The results obtained confirmed the possibility of using Gaviscon as an effective anti-relapse therapy for GERD. In the study of I.G. Pakhomova et al. when conducting 24-hour monitoring of intragastric and intraesophageal pH in patients while taking Gaviscon forte suspension for 14 days, there was a complete disappearance of heartburn, bitterness in the mouth, retrosternal esophageal pain and pain in the epigastric region by the end of treatment. Evaluation of the results of daily pH monitoring showed that the drug has a pronounced antireflux effect.

Clinical studies conducted by Yu.P. Uspensky et al. (2007) showed that the use of Gaviscon forte suspension for 14 days significantly reduces the percentage of time with intragastric pH<2 в ночные часы у большинства пациентов с ГЭРБ (рис. 1) .

Rice. 1. Dynamics of daily intragastric pH monitoring during treatment with Gaviscon forte suspension at night (time with pH less than 2)

Uspensky Yu.P. et al. 2007

When assessing the dynamics of intraesophageal pH during treatment with Gaviscon forte suspension, the percentage of daily time with pH<4 в пищеводе уменьшился с 12,7 до 4,3, общее число рефлюксовсо 161 сократилось до 52,2, а количество рефлюксов длительностью более 5 минут - с 5 до 1,8. Самый длинный рефлюкс при этом сократился вдвое. Было отмечено значительное, вплоть до полного исчезновения снижение частоты эпизодов изжоги уже на 2-й день лечения, а к концу терапии данный симптом был полностью купирован. Проявления «желчного» рефлюкса также регрессировали к окончанию терапии, равно как и купирование эпигастральных болей, которые имели место у ряда пациентов. Своими исследованиями авторы подтвердили, что, с одной стороны, Гевискон, подобно антацидам, не влияет на механизмы выработки соляной кислоты в желудке, обеспечивая лишь нейтрализацию последней. При этом образуется гель, который обволакивает слизистую оболочку желудка, предохраняя ее от дальнейшего воздействия соляной кислоты и пепсина. Но, с другой стороны, согласно многочисленным литературным свидетельствам данная группа альгинатсодержащих препаратов, подобно секретолитическим средствам, обладает существенными временными рамками для поддержания интрагастрального рН>4 units, which is an essential condition for achieving clinical and endoscopic remission in acid-dependent diseases.

Heartburn is a common symptom in pregnant women, with 45-85% of them experiencing it daily. Heartburn and reflux tend to be most uncomfortable in the third trimester of a normal pregnancy. The appearance of heartburn during pregnancy is considered not only as an unpleasant, painful symptom, but also as a cause of the development of GERD in the future. And the more pregnancies, the higher this risk. The mechanism for the development of heartburn during pregnancy is not fully understood. It is assumed that the effect of progesterone on the tone of the lower esophageal sphincter, the amplitude of peristaltic waves, and the increase in intra-abdominal pressure due to changes in the size of the uterus with the fetus contribute to gastroesophageal reflux. Their natural dynamics as the duration of pregnancy intensifies heartburn.

Under the influence of placental hormones and under the influence of intra-abdominal pressure from a growing fetus, the work of the lower esophageal sphincter (LES) worsens, mainly in the third trimester. Relaxation of the LES can cause stomach acid to flow more freely into the esophagus. Although symptoms are usually mild to moderate in intensity and self-resolve after childbirth, they can cause more discomfort than other potentially more serious conditions, as well as disturb sleep and digestion, thereby indirectly adversely affecting the mother and fetus. Relief of GERD symptoms during pregnancy is difficult. In an open study in 50 women in the second and third trimesters of pregnancy, the effect of liquid Gaviscon on the relief of heartburn, belching, dyspepsia and burning in the epigastric region was evaluated. The use of the drug provided a statistically significant decrease in the frequency, intensity and duration of symptoms one month after the start of its administration. A positive effect was observed in 98% of patients. G.D. Lang and A. Dougall in a study involving 157 pregnant women compared the effect of a combined suspension containing alginate and antacid, and a conventional antacid for the relief of dyspepsia. Both treatments were found to be equally effective in a two week trial.

An open randomized study conducted by E.V. Onuchina et al. (2010) of the use of Gaviscon forte at a dose of 10 ml / day on demand in 110 consecutive pregnant women in accordance with the ethical requirements of the Declaration of Helsinki found that the overall frequency of heartburn among pregnant women was 56.4%, weekly -49.1% . At the second stage - in persons with symptoms of GERD in a longitudinal study, the use of the drug Gaviscon forte was studied for 4 weeks at a dose of 10 ml / day in an on-demand regimen. In pregnant women with heartburn, factors such as overweight (BMI from 25 to 29 kg/m2) or obesity (BMI from 30 kg/m2) before and during pregnancy, heartburn before pregnancy, smoking, and the presence of relatives with heartburn prevailed. The average term for the appearance of heartburn corresponded to 9.9±8.8 weeks of pregnancy. The authors established a moderate correlation (r=0.49, p=0.0001) between the duration of pregnancy and the severity of heartburn. Regurgitation bothered 50% of pregnant women, retrosternal pain - 6.4%, the frequency and severity of these symptoms were significantly higher in the group of pregnant women with heartburn. During endoscopy, no changes in the esophageal mucosa were observed in all cases of reflux symptoms. When analyzing the methods of stopping reflux symptoms, it was found that in 24.2% of pregnant women, heartburn, belching and retrosternal pain went away on their own, in 37.1% - after taking any liquid, in 11.3% - after taking soda. Medications were used by less than a third of pregnant women (27.4%). Of these, 82.4% took antacids, 17.6% - Gaviscon forte. Antacids are traditionally classified as low-risk drugs during pregnancy. At the same time, excessive consumption of calcium carbonate, which is part of them, can lead to the development of Burnett's milk-alkaline syndrome, anemia and constipation in pregnant women.

In addition, hyperaluminemia and hypermagnesemia caused by long-term use of antacids can be associated both in the mother and in the fetus with a neurotoxic effect, osteodystrophy, nephrolithiasis, hypotension and respiratory distress syndrome. Apginate drug Gaviscon, forming a stable non-absorbable barrier in the stomach, preventing refluxate from entering the esophagus, does not have a systemic effect on the mother and fetus. In an open multicentre study, Lindow S. W. et al. (2003) established the safety and high efficacy of Gaviscon forte for the relief of heartburn and regurgitation at all stages of pregnancy. By the 28th day of the study, in the Gaviscon forte group, heartburn completely disappeared in 90.3% of pregnant women (p = 0.00001), while in the control group, the incidence of heartburn remained the same. In the Gaviscon forte group, a significant decrease in the frequency and severity of general heartburn, complete relief of weekly, daily and nocturnal heartburn were revealed, while in the control group with a natural course of heartburn in conditions of an increase in hormonal levels and the size of the uterus with the fetus, a significant increase in the frequency of weekly heartburn and unreliable negative trend in daily and nocturnal heartburn. Concerns that medications taken during pregnancy may harm the developing fetus lead to the fact that, in addition to lifestyle recommendations, treatment of pregnant women with heartburn usually begins with milder methods - simple antacids or alginate-based antireflux drugs. Although the fetus's major organ structures are developed by the 12th week and there is a period of sensitivity to malformations until the 16th week, medications taken later in pregnancy can also harm the developing fetus. Gaviscon forte is a unique alginate-based antireflux drug that contains significantly less sodium per dose. It is known that Gaviscon consists of: sodium alginate (500 mg/10 ml), sodium bicarbonate (267 mg/10 ml), calcium carbonate (160 mg/10 ml) and a number of auxiliary components. Gaviscon forte - from sodium alginate (1000 mg / 10 ml), potassium bicarbonate (200 mg / ml) and excipients. . It forms a stable, non-absorbable barrier in the stomach to prevent acid and food from entering the esophagus, which can damage the esophageal mucosa and cause heartburn. This non-systemic mode of action means that, unlike other treatments for heartburn and GERD, the use of the drug during pregnancy does not pose a risk to the mother or baby. Moreover, the non-systemic mode of action of Gaviscon Forte cannot be affected by biological changes associated with pregnancy.

In an open, multicentre study conducted in hospitals and maternity hospitals in the UK and South Africa, pregnant women (<38 недель беременности, п=83) в возрасте 18-40 лет, страдающие от изжоги, должны были принимать при необходимости 5-10 мл Гевискона форте для облегчения симптомов. Также документально фиксировалась информация о возможном неблагоприятном воздействии Гевискона форте на мать, плод и новорожденного. После четырех недель оценки эффективности Гевискона форте на основе пятибалльной шкалы результаты «очень хорошая» и «хорошая» были задокументированы у 88 и 90% женщин соответственно. Большинство женщин (57%, п=83) сообщали об облегчении симптомов в течение 10 минут. Данное исследование подтвердило, что Гевискон форте эффективно и быстро снижает изжогу во время беременности, а также безопасность его применения при беременности как для матери, так и для ребенка [Международный Журнал клинической практики, 2003; 57(3): 175-179].

In children, diseases of the esophagus, according to various authors, account for 18-25% of all diseases of the digestive system. The frequency of GERD in children ranges from 2-4 to 8.7-49%. For pediatric practice, the relevance of the problem under consideration is determined, on the one hand, by the high incidence of GERD among diseases of the gastrointestinal tract (GIT), the frequent involvement of the esophagus in the pathological process, and, on the other hand, by the frequency of extraesophageal manifestations of the disease. In childhood, extraesophageal symptoms are most common in the bronchopulmonary system and ENT organs. According to various sources, the frequency of detection of GERD in bronchial asthma in children ranges from 9 to 80% (depending on the criteria used by various working groups). In modern literature, there are many reports on the relationship of GERD with other diseases of the bronchopulmonary system - the pathology of the larynx, pharynx, recurrent and chronic bronchitis, cystic fibrosis. Gaviscon has proven itself in the treatment of regurgitation and associated reflux in children of all ages. The safety of its use was confirmed by numerous toxicological studies conducted in the world in the 40-70s of the XX century. . A.R. Weldon and M.J. Robinson reported back in 1972 the use of Gaviscon to relieve the symptoms of gastroesophageal reflux in children as young as 2 weeks of age. up to 11 months . The powder of the drug, mixed with food, reduced vomiting and was found to be an effective treatment for esophageal reflux. In a larger open study by V. Le Luyer et al. (1992) the use of liquid Gaviscon 1-2 ml / kg per day significantly reduced belching and vomiting in 76 infants.

In a double-blind, randomized, multicenter study, A. Sookoo et al. evaluated the efficacy and safety of Gaviscon Infant without aluminum in children under 1 year of age. The study included 90 infants with signs of gastroesophageal reflux in the form of vomiting or belching. The multiplicity and intensity of their manifestations were assessed. The drug was significantly more effective in eliminating the symptoms of gastroesophageal reflux compared to placebo. A placebo-controlled study by J.R Buts et al. confirmed the effectiveness of Gaviscon in the treatment of belching and vomiting in 20 children of different ages in two groups: 10 children (mean age 21 months) received Gaviscon, 10 children (mean age 35 months) - placebo. Pathological disorders were diagnosed in all patients before the start of the study based on the assessment of the Euler-Byrne index, the total number of refluxes per 24 hours, the average duration and the number of refluxes during sleep. A week before and after treatment, all patients underwent daily monitoring of the pH of the lower third of the esophagus. According to established criteria, GERD was diagnosed in 13 of 20 patients, although esophagitis was not detected in any child endoscopically. During therapy with Gaviscon, the number of refluxes significantly decreased, while no clinical effects were noted in the control group. After 8 days of treatment with the drug, the results of pH-metry showed significant (p<0,05) снижение величин с -35 до -61 % в сравнении с первоначальными, показателями. В контрольной группе средние показатели демонстрировали минимальные изменения (-9,5% к +8,2% по сравнению с исходными величинами) .

In a multicenter, parallel, randomized study conducted by S. Miller, the composition of Gaviscon Infant without aluminum was compared with placebo in 48 children with recurrent gastroesophageal reflux (mean patient age 4 years). Over two weeks of treatment, the drug showed a significant advantage over placebo in reducing the number of episodes of vomiting / belching and reducing the intensity of vomiting attacks; the mixture was rated by both parents and investigators as significantly superior to other formulations. In a study by P. Greally et al. compared cisapride monohydrate and the combination of Gaviscon and Carobel (thickener) for the management of chronic vomiting and reflux in 50 children aged 2 to 18 months. Gastroesophageal reflux was confirmed by 24-hour esophageal pH monitoring. Children received the drug for a month. Improvement was seen in 14 of 26 (53%) patients treated with cisapride monohydrate and in 19 of 24 (79%) treated with Gaviscon and Carobel. According to the daily records of parents in the second group, there was more progress in treatment compared to baseline. At the end of the monthly course of therapy, intraesophageal pH was again assessed. At the same time, those who received Gaviscon showed more significant positive changes in indicators compared to those who received cisapride monohydrate. G. Oderda et al. compared the action and tolerability of famotidine and Gaviscon in children with endoscopically confirmed erosive esophagitis (mean patient age 9 years). After 6 months treatment based on repeated endoscopic examination, the disappearance of signs of esophagitis was recorded in 43.4% of children who received famotidine, and in 41.6% of those who received Gaviscon. Histological examination showed no signs of esophagitis in 70.8% and 52.2% of cases, respectively (p<0,001). Никаких нежелательных явлений, а также токсического воздействия не наблюдалось ни в одной из групп . Изучение возможности в коррекции клинических проявлений патологического гастроэзофагеального рефлюкса (ГЭР) у 117 детей, имеющих клинические, эндоскопические, рентгенологические и рН-метрические признаки дисфункции кардиоэзофагеального перехода, показало эффективность препарата Гевискон в устранении клинических признаков ГЭР как в монотерапии, так и в сочетании с антацидами и ингибиторами протонной помпы, что позволило авторам рекомендовать его к использованию у детей всех возрастных групп с рефлюкс-эзофагитом любой степени . В то же время, необходимо отметить, что представленные на российском рынке в настоящий момент препараты Гевискон/Гевискон Форте показаны к применению с 6/12 лет.

Despite the existing successes in the treatment of GERD, there are reserves for improving these results, associated with the maximum individualization of approaches to the treatment of patients, taking into account not only the quality of life, patient characteristics and the state of the mucosa of the esophagogastroduodenal zone, but also taking into account the presence of concomitant pathology in patients from the side of the cavity. mouth. The significant prevalence of periodontal diseases, the lack of a trend towards a decrease in periodontal morbidity dictate the need for closer attention to the early diagnosis and rational treatment of this pathology against the background of GERD. It has been statistically proven that there are 2.8 per patient younger than 20, 2.9 at the age of 21-40, 4.5 at the age of 41-60, which shows the impossibility of carrying out "isolated therapy" of inflammatory periodontal diseases. regardless of the general somatic status of the patient. In this regard, establishing the effect of proton pump inhibitors (PPIs) and alginates in the treatment of GERD on the dynamics of periodontal disease is an urgent problem in modern dentistry. These data will allow not only to determine the mutual influence of diseases of the esophagus and periodontium, to identify the relationship between GERD therapy and the local state of the gum tissue, but also to develop their adequate complex treatment.

In a study by T.D. Dzhamaldinova (2010) involved 138 people (mean age 36.5±4.2 years, 47.1% men and 52.9% women) with chronic catarrhal gingivitis (CCG) and mild chronic generalized periodontitis ( HGPl), occurring against the background of GERD and without this concomitant pathology from the gastrointestinal tract. The GERD treatment group included 26 patients with chronic catarrhal gingivitis and 22 patients with mild chronic generalized periodontitis. Gaviscon (subgroup A - n=25) was prescribed 20 ml of suspension 30-40 minutes after meals 4 times a day (the last dose of the drug before bedtime) with a main course duration of 8 weeks. In subgroup B (n=23), omeprazole 20 mg 2 times a day was used for the treatment of GERD, the course was 8 weeks. Then the patients were transferred to maintenance therapy. In the comparison group (n=45) with inflammatory periodontal disease and concomitant GERD, GERD therapy was not used. I control group - 30 patients with inflammatory periodontal diseases without GERD (15 people with HCG and 15 patients with CHPl). Control group II consisted of 15 practically healthy people with intact periodontal disease without GERD.

Patients with HCG and CHPL of all comparison groups underwent complex treatment of periodontal diseases according to the traditional scheme, the purpose of which was to eliminate inflammatory processes in the gum tissues and eliminate periodontal pockets. Analysis of the results of endoscopy in patients with GERD and evaluation of clinical examination data of patients with periodontal pathology showed that the frequency of verification and the nature of inflammatory lesions of the periodontium differ in different forms of GERD, and chronic catarrhal gingivitis was significantly more often diagnosed with endoscopically negative and catarrhal esophagitis than with erosive reflux esophagitis, while HGPl - in catarrhal and erosive reflux esophagitis. With a detailed distribution of the dependence of the stage of GERD and the presence of inflammatory periodontal diseases, it was revealed that endoscopically negative GERD was diagnosed in 49.5% of cases, which was in 69.6% of patients with chronic hepatitis C, and in 30.4% of patients with generalized periodontitis. mild degree. In 43% of cases, the catarrhal stage of GERD was detected, which was diagnosed in 35% of cases in patients with HCG and in 65% of cases in patients with CHPL. Erosive reflux esophagitis in 100% of cases occurred only in patients with CHPL. A feature of the course of HCG and CHPL against the background of GERD was that in 60.2% of patients, signs of gingivitis and periodontitis appeared during exacerbation of the pathology of the esophagus. During a clinical study, patients had complaints characteristic of GERD - heartburn, belching, dysphagia and pain in the epigastric region. A detailed analysis of the positive dynamics of the course of GERD and the regression of clinical symptoms made it possible to conduct a comparative assessment of the effectiveness of the use of omeprazole and Gaviscon in the treatment of GERD and showed a comparable effectiveness of the use of these drugs. According to the control EGDS after 8 weeks. therapy for GERD, a pronounced positive trend was noted: there was an increase in the proportion of patients with endoscopically negative GERD by 1.72 times (p<0,05) и уменьшение доли больных с катаральным и эрозивным рефлюкс-эзофагитом.

When comparing the effect of Gaviscon and omeprazole on the dynamics of periodontal microcirculation parameters in CCG and CHPL against the background of GERD, there were no significant differences in the dynamics of microcirculatory parameters obtained with control LDF-grams (p>0.05). When assessing the parameters of microcirculation of periodontal tissues of the I group of comparison in patients with HCG and CHPL against the background of GERD, the authors noted the normalization of these parameters after complex therapy of GERD and inflammatory periodontal disease compared with the data of LDF-grams of patients of the II group of comparison receiving only symptomatic therapy GERD. Based on the data obtained, the author concluded that there is a pathogenetic relationship between inflammatory periodontal diseases and the presence of pathological gastroesophageal reflux and that Gaviscon is effective in eliminating these disorders.

As mentioned above, the objective criteria for the diagnosis of GERD make it possible to obtain instrumental methods (EGD, pH-metry of the esophagus), but not in all patients. Thus, EGDS can reveal changes in the mucosa of the distal esophagus, primarily reflux esophagitis, which determines its high specificity. However, in most patients with complaints of heartburn and other symptoms associated with reflux, the esophageal mucosa is not macroscopically changed, which makes endoscopy insensitive for diagnosing endoscopically negative GERD. Thus, the absence of endoscopic changes on examination of the esophagus does not rule out GERD. Pathological acid reflux detected during daily pH monitoring of the esophagus (pH<4,0) также встречается не у всех больных с изжогой . Вис-следовании, проведенном в ЦНИИ гастроэнтерологии, при рН-мониторинге у 250 больных с ГЭРБ кислотный рефлюкс был выявлен лишь в 61,6% . Следовательно, отсутствие кислотного рефлюкса не исключает диагноза ГЭРБ. Новые технологии рефлюкс-мониторинга -комбинированный внутрипросветный многоканальный импеданс-рН-мониторинг дает возможность наряду с кислыми выявлять слабокислые и слабощелочные, а также жидкие и газовые рефлюксы, оценить уровень распространения рефлюкса и длительность воздействия факторов агрессии на слизистую оболочку пищевода. Возможно, эта методика может стать «золотым стандартом» в диагностике ГЭРБ, но пока она мало доступна. Оценить давление нижнего пищеводного сфинктера (НПС) позволяет манометрия пищевода. Однако при обследовании 250 больных с ГЭРБ в ЦНИИГ низкое давление НПС (<10 мм. рт.ст.) было выявлено лишь у 26,8%. Поэтому манометрия пищевода является преимущественно методом дифференциальной диагностики первичных и вторичных заболеваний пищевода (системные заболевания, склеродермия, сахарный диабет). Перечисленные инвазивные методики диагностики ГЭРБ дороги и не всегда доступны . Вот почему дополнительным критерием диагностики ГЭРБ является оценка эффективности пробного лечения и в качестве диагностического теста широко используется тест с ИПП. Ликвидация симптомов ГЭРБ к 7-му дню приема ИПП расценивается, как подтверждение диагноза ГЭРБ. Особенности фармакокинетики ИПП (короткий период полураспада, медленное развитие антисекреторного эффекта) не позволяют учесть результаты теста с ИПП ранее 7-го дня лечения. В то же время альгинаты при приеме внутрь быстро образуют альгинатный гелевый барьер на поверхности содержимого желудка, физически препятствующий возникновению гастроэзофагеального рефлюкса. При оценке эффекта однократного приема альгинатов у больных с ГЭРБ показано, что Гевискон купирует изжогу в среднем через 3,3 мин., Гевискон форте через 3,6 мин . При обследовании 123 пациентов с симптомами ГЭРБ однократный прием 20 мл суспензии Гевискона купировал изжогу у 91 (78,9%) больного , 87 из них был установлен диагноз ГЭРБ по данным ЭГДС и суточного рН-мониторинга. Полученные данные позволили Д.С. Бордину и соавт. (2011 г.) рекомендовать острую фармакологическую пробу с альгинатом в качестве скринингового теста в диагностике ГЭРБ. Альгинатный тест, обладая высокой чувствительностью и специфичностью, значительно сокращает время диагностического поиска, существенно снижая временные и финансовые затраты на диагностику ГЭРБ , что особенно важно как в условиях первичной медико-санитарной помощи, так и для здравоохранения в целом.

It is also relevant to note the prebiotic properties of alginates, which make it possible to use them to correct various disorders of the intestinal microbiocenosis. It was found that alginates help maintain the optimal qualitative and quantitative composition of intestinal microorganisms by increasing the content of obligate (bifidobacteria, lactobacilli) and reducing opportunistic and pathogenic bacteria, such as staphylococci, fungi of the genus Candida, etc. In addition, it is known that sodium and calcium salts of alginic acid reduce excessive intestinal motility. Thus, all the above circumstances allow us to conclude that Gaviscon, while showing high efficiency in relieving GERD symptoms, can also have a positive clinical and metabolic effect when GERD is combined with a number of other diseases, which requires further study of the prospects for including Gaviscon in treatment regimens. various diseases.

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